Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps.

Background: Polypectomy with cold biopsy forceps is a frequently used technique for removal of small, sessile, colorectal polyps. Jumbo forceps may lead to more effective polypectomy because of the larger size of the forceps cup.

Objective: To evaluate the efficiency of cold jumbo biopsy forceps compared with standard forceps for polypectomy of small, sessile, colorectal polyps.

Diagnosis and management of ampullary adenoma: The expanding role of endoscopy.

Ampullary adenoma is a pre-cancerous lesion arising from the duodenal papilla that is often asymptomatic. It is important to distinguish whether the adenoma is sporadic or arises in the setting of familial adenomatous polyposis as this has important implications with respect to management and surveillance. Multiple modalities are available for staging of these lesions to help guide the most appropriate therapy.

[Physical projects atelier: strategy for physical resources administration learning on nursing].

The success of learning involves adequate strategies. Those inspired on andragogy, which is the science of teaching adults, seem to be ideal for the nursing undergraduate subject "projects", with a focus on the administration of physical resources for nursing. This study reports teaching strategies that try to estimulate the acquisition of competences that make the nurse capable of a dialogue on projects with a multiprofessional team.

The practice of evidence-based medicine (EBM) in gastroenterology: discrepancies between EBM familiarity and EBM competency.

Introduction: Evidence-based medicine (EBM) has become increasingly important in the practice of gastroenterology and endoscopy, and the training of future gastroenterology physicians. The objectives were to assess the attitudes/opinions of gastroenterology specialists towards EBM, and evaluate possible gaps in education for certain EBM-related concepts.

Methods: An internet-based survey was emailed to 4073 gastroenterology specialists.

Algorithm for the management of endoscopic perforations: a quality improvement project.

Perforations are an uncommon but serious complication of endoscopy. Although they are well recognized, no universally accepted strategy for their management exists. The need for management algorithms in situations that call for multiple interventions in a short time, with coordinated effort encompassing multiple providers from different specialties, has long been recognized, but no such clinical care pathway has been developed for the management of endoscopic perforations.

Prospective evaluation of the clinical utility of ERCP-guided cholangiopancreatoscopy with a new direct visualization system.

Background: Older systems for cholangiopancreatoscopy have demonstrated improved diagnostic and therapeutic abilities over standard ERCP but have shown limited feasibility. The SpyGlass Direct Visualization System addresses many of the shortcomings of the older platforms, but its potential advantages have not been rigorously evaluated.

Objective: To prospectively evaluate the feasibility, clinical efficacy, and safety of the SpyGlass system.

The utility of repeat endoscopic ultrasound-guided fine needle aspiration for suspected pancreatic cancer.

Background. The utility of repeat EUS in patients with suspicion for pancreatic cancer after non-diagnostic EUS-FNA study is not well established. Aim.

Intraobserver agreement among endosonographers for endoscopic ultrasound features of chronic pancreatitis: a blinded multicenter study.

Objective: Assess intraobserver agreement among endosonographers for endoscopic ultrasound (EUS) features of chronic pancreatitis (CP).

Methods: Thirty EUS images from patients with suspected CP were shown twice in random order to 5 blinded endosonographers. The following accepted features of CP were assessed: (1) hyperechoic foci, (2) hyperechoic strands, (3) lobularity, (4) cysts, (5) stones, (6) main pancreatic duct dilatation, (7) pancreatic duct irregularity, (8) hyperechoic duct margins, (9) visible side branches, and (10) overall assessment for CP.

Spiral enteroscopy: prospective U.S. multicenter study in patients with small-bowel disorders.

Background: The performance characteristics of spiral enteroscopy have not been well-described.

Objective: To determine the technical performance, diagnostic and therapeutic yields, and safety of oral spiral enteroscopy in patients with suspected or established small-bowel pathology.

Design: Prospective, multicenter, cohort study, with centralized database.

Diagnostic yield of spiral enteroscopy when performed for the evaluation of abnormal capsule endoscopy findings.

Background: Spiral enteroscopy (SE) has emerged as a new alternative for deep intubation of the small intestine. SE is most often used to evaluate abnormal findings on capsule endoscopy (CE).

Objective: Investigate the ability of SE to reproduce abnormal findings detected on preceding CE.

Fully covered Alimaxx esophageal metal stents in the endoscopic treatment of benign esophageal diseases.

Background: Expandable esophageal stents are widely used for the palliation of dysphagia in patients with esophageal cancer and are also beginning to be used in patients with benign esophageal diseases such as refractory strictures and fistulas. There is concern regarding the increased risk of migration of the fully covered Alimaxx metal esophageal stent and experience with this stent in benign esophageal pathology has been reported in only a small series of patients.

Aims: To evaluate the technical success in placement and removal, efficacy and complications of the Alimaxx esophageal stent for benign esophageal diseases.

Hepatotoxic effects of therapies for tuberculosis.

Hepatotoxic effects attributable to antituberculosis therapy are considered unique among drug-related liver problems because almost all first-line antituberculosis medications have such adverse effects, which vary in severity according to the drug and the regimen. In addition, all regimens for the treatment of active tuberculosis include a combination of medications that must typically be administered for at least 6 months to ensure complete cure of the disease and to minimize the development of drug-resistant bacterial strains. Hepatotoxic effects are a serious problem in patients who are undergoing treatment for tuberculosis, not only because of the morbidity and mortality they directly cause, but also because the liver symptoms can necessitate interruption of therapy or affect a patient's adherence to it, which can limit the efficacy of the antitubercular regimen.

Colonoscopic polypectomy and associated techniques.

Polypectomy of colonic polyps has been shown to reduce the risk of colon cancer development and is considered a fundamental skill for all endoscopists who perform colonoscopy. A variety of polypectomy techniques and devices are available, and their use can vary greatly based on local availability and preferences. In general, cold forceps and cold snare have been the polypectomy methods of choice for smaller polyps, and hot snare has been the method of choice for larger polyps.

Prospective evaluation of gastroenterologist-guided, nurse-administered standard sedation for spiral deep small bowel enteroscopy.

Background: Sedation of patients for deep small bowel enteroscopy presents unique challenges and is traditionally provided by anesthesiologists. No study has directly evaluated gastroenterologist-guided, nurse-administered sedation for deep enteroscopy. Further, no comparison exists between gastroenterologist-guided versus anesthesiologist-guided sedation during deep enteroscopy.

Spiral enteroscopy is safe and effective for an elderly United States population of patients with numerous comorbidities.

Background & Aims: Preliminary studies performed outside of the United States demonstrated that spiral enteroscopy is safe and effective when performed in young, healthy patients. However, spiral enteroscopy has not been evaluated in a US population of patients with numerous comorbidities. We evaluated the feasibility, efficacy, and safety of spiral enteroscopy in a US population of older patients with multiple comorbidities and a high prevalence of pathologic findings.

Diagnostic evaluation of pancreatic cystic malignancies.

Cystic neoplasms of the pancreas are increasingly recognized because of expanding use and improved sensitivity of cross-sectional imaging studies. Major advances in the last decade have led to an improved understanding of the various types of cystic lesions and their biologic behavior. Despite significant improvement in imaging technology and the advent of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) the diagnosis and management of pancreatic cystic lesions remains a significant clinical challenge.

Prospective randomized blinded comparison of a short-wire endoscopic retrograde cholangiopancreatography system with traditional long-wire devices.

Background: Short-wire endoscopic retrograde cholangiopancreatography (ERCP) systems are perceived to carry advantage over traditional long-wire devices. To date, this potential advantage has not been well documented, and gastroenterologists are confronted in everyday practice with the dilemma of choosing a particular system without the benefit of having objective comparative data.

Aims: The aim of this study was to compare the performance characteristics of the Fusion ERCP short-wire system with traditional long-wire devices.

Squamous cell cancer of the rectum.

Squamous cell carcinoma of the rectum is a rare malignancy. It appears to be associated with chronic inflammatory conditions and infections. The clear association seen between Human Papilloma Virus and various squamous cancers has not been firmly established for the squamous cell cancer of the rectum.

Paraneoplastic dermatological manifestation of gastrointestinal malignancies.

Numerous dermatological disorders have been associated with underlining malignancies of the gastrointestinal (GI) tract. Such cutaneous manifestations might have an important diagnostic value if they are the sole expressions of otherwise asymptomatic carcinomas. The recognition of some typical paraneoplastic dermatologic disorders can lead to the prompt diagnosis of the underlying malignancy, timely administration of therapy, and ultimately, better prognosis.